Nasal congestion and rhinorrhea (runny nose) are very common problems that often occur together, but sometimes alone. Etiology The most common causes (see Table: causes of a stuffy and runny nose) are: viral infections allergic reactions causes of a stuffy and runny nose caused Suspicious findings diagnostic approach Acute sinusitis mucopurulent discharge, often one-sided Reddened mucosa occasionally unpleasant or metallic taste, focal face / headache, redness or tenderness over pine or sinus CT Clinical evaluation at Pat ienten with diabetes, immune deficiencies or signs of serious illness allergies Watery discharge, sneezing, watery, itchy eyes, pale, swollen nasal symptoms often seasonal or by exposure to possible triggers Clinical clarification abuse decongestants nasal congestion decongestant with diminishing resources Pale, strong swollen mucosa Clinical evaluation Nasal foreign body sided, malodorous (sometimes bloody) discharge in a child Clinical evaluation Vasomotor rhinitis Recurring watery discharge, sneezing, red, swollen mucosa no detectable triggers Clinical evaluation Viral infections of the upper respiratory tract Aqueous up mucous discharge, accompanied by sore throat, fatigue, reddened nasal mucosa Clinical evaluation also dry air can be swell up nose. Something rare is an acute sinusitis, and rarely a foreign body in the nose (v. A. In children) of the base. Are decongestant nasal drops applied> 3-5 days, often takes the paradoxical response to that the nasal mucosa with decreasing drug effect significantly swells – and therefore many patients take decongestants constantly, resulting in a vicious cycle to continuous strengthening of constipation. This drug induced rhinitis is a situation that may continue for some time and partly wrong is estimated (not as a treatment episode, but continues to exist original problem). Clarification history The history of the disease process, where the nature of the effluent (eg. As watery, slimy, festering, bloody) determine and whether it is chronic or recurrent. If recurrent, any reference to location, season or exposure to potentially triggering allergens (numerous) should be determined. A one-sided, clear, watery discharge, especially when it follows a head injury, a cerebrospinal fluid (CSF) leak tested can mean. A CSF discharge can also occur spontaneously in obese women in their 40s, secondary to idiopathic intracranial hypertension. In reviewing the organ systems of possible causes (sinusitis), watery, itchy eyes (allergies) and sore throat, nausea, fever and cough (viral infection of the upper respiratory tract) should be sought for symptoms, including fever and facial pain. The history should ask about known allergies and after diabetes or immune deficiency. When Medikamentenanamese concrete questions about the use of decongestants werden.K├Ârperliche investigation should Vital signs should be checked for fever. The physical examination focuses on the nose and skin areas over the sinuses. The face is inspected on focal redness on the forehead and maxillary sinuses; these areas are to be sampled on pressure sensitivity. The nasal mucosa (eg red or pale.) To color, swelling, color and type of discharge, and (especially in children) for foreign bodies to inspizieren.Warnzeichen The following findings are particularly significant: one-sided, v. a. purulent or bloody discharge facial pain and / or tenderness interpretation of the findings symptoms and examination are often sufficient to make a diagnosis (see table: causes of a stuffy and runny nose). A unilateral, fetid nasal discharge suggests a foreign body in the nose in children. Is it possible to find no foreign body, should a purulent rhinorrhea, holding> 10 days and is accompanied by coughing and fatigue, think of a sinusitis lassen.Tests For acute symptoms, further investigations are generally indicated only if in diabetic or immunocompromised patients suspected an invasive sinusitis consists. In these patients, a CT should be performed. When a CSF leak is suspected, a sample of the precipitation should be tested for the presence of beta-2 transferrin is highly specific for the CSF. Specific findings therapy are treated. Nasal congestion locally or oral decongestants to relieve symptoms. Among the locally applied decongestants belongs oxymetazoline (2 sprays in each nostril twice daily 1 or 2 times daily for 3 days). Among the orally applied decongestants pseudoephedrine belongs (2 times daily 60 mg). However, a longer-term use should be avoided. A viral rhinorrhea can with oral antihistamines (e.g., diphenhydramine, 2 times 25-50 mg p.o. daily) to be treated, which in addition to their H2-inhibiting action in addition anticholinergic properties. In allergic mucosal swelling and rhinorrhea antihistamines may also be added, but in the case of effective antihistamines are nichtanticholinerg (z. B. fexofenadine, 2 times 60 mg p.o. daily) fewer side effects. Nasal corticosteroids (such. As daily 2 sprays in each nostril mometasone) also help with allergic diseases. Antihistamines and decongestants are not recommended in children <6 years. Basics of Geriatrics antihistamines may have sedative and anticholinergic effects and should be administered in elderly patients at a reduced dosage. Likewise sympathomimetic should be used in the lowest clinically effective dose. Summary Most cases of nasal congestion and rhinorrhea are caused by infections of the upper respiratory tract and allergies. In children, a foreign body should always be considered. A rebound effect due to excessive application locally decongestants should also be considered.

Health Life Media Team

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